{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:55:10Z","timestamp":1792788910631,"version":"4.5.0"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T00:00:00Z","timestamp":1758499200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To investigate refractive development, myopia prevalence trends, and correction status among 6\u201312-year-old primary students in Xingtai, Hebei, China, and provide evidence for childhood myopia interventions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This cross-sectional study enrolled 12,025 eligible students (6\u201312\u202fyears) from 11 schools (2022\u20132023). Refractive status was assessed via non-cycloplegic autorefraction (NIDEK AR-1), with ocular biometry [axial length (AL), keratometry (K)]. Diagnostic criteria: spherical equivalent (SE)\u202f&amp;lt;\u202f\u22120.50D (myopia), <jats:italic>K<\/jats:italic> \u2264\u202f\u22120.50D (astigmatism), uncorrected\/corrected visual acuity &amp;lt;5.0\/&amp;lt;4.9 (subnormal vision\/insufficient correction).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Visual impairment prevalence was 65.65% (7,895\/12,025), rising significantly from 58.00% (Grade 1) to 75.75% (Grade 6). Myopia prevalence increased from 30.41% to 68.78% (overall 51.69%). SE shifted myopically (\u22121.46\u202f\u00b1\u202f1.84D overall; Grade 1: \u22120.66\u202f\u00b1\u202f1.54D vs. Grade 6: \u22122.20\u202f\u00b1\u202f2.01D). AL increased with grade (23.64\u202f\u00b1\u202f1.07\u202fmm overall; 22.95\u202f\u00b1\u202f0.83\u202fmm to 24.13\u202f\u00b1\u202f1.12\u202fmm), while corneal curvature remained stable (43.39\u202f\u00b1\u202f1.51D; inter-grade variation &amp;lt;0.13D). The AL\/corneal radius ratio correlated linearly with SE (3.02\u202f\u00b1\u202f0.17 overall; 2.95\u202f\u00b1\u202f0.10 to 3.08\u202f\u00b1\u202f0.14).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Vision impairment and myopia prevalence show higher prevalence in older age groups in Xingtai primary students. Suboptimal refractive correction rates highlight clinical challenges. AL progression and stable corneal curvature suggest axial elongation drives myopia. The AL\/corneal radius ratio\u2019s correlation with SE underscores its potential as a predictor for myopia progression, aiding risk prediction model development.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1660018","type":"journal-article","created":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T05:30:20Z","timestamp":1758519020000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Analysis of refractive development characteristics in school-age children based on biometric measurements: a cross-sectional study involving 12,025 primary school students from Xingtai City"],"prefix":"10.3389","volume":"13","author":[{"given":"Jie","family":"Gao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lizhu","family":"Meng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xi","family":"Lv","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ye","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanyan","family":"Liang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,22]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1186\/s12886-019-1220-0","article-title":"A review on the epidemiology of myopia in school children worldwide","volume":"20","author":"Grzybowski","year":"2020","journal-title":"BMC Ophthalmol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1036","DOI":"10.1016\/j.ophtha.2016.01.006","article-title":"Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050","volume":"123","author":"Holden","year":"2016","journal-title":"Ophthalmology"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1097\/IAE.0000000000002590","article-title":"Prevalence and time trends of myopia in children and adolescents in CHINA: a systemic review and meta-analysis","volume":"40","author":"Dong","year":"2020","journal-title":"Retina"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"112472","DOI":"10.1016\/j.biopha.2021.112472","article-title":"Advances in biomedical study of the myopia-related signaling pathways and mechanisms","volume":"145","author":"Yang","year":"2022","journal-title":"Biomed Pharmacother"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2022\/1004977","article-title":"Myopia: mechanisms and strategies to slow down its progression","volume":"2022","author":"Russo","year":"2022","journal-title":"J Ophthalmol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1111\/opo.12305","article-title":"Age of onset of myopia predicts risk of high myopia in later childhood in myopic Singapore children","volume":"36","author":"Chua","year":"2016","journal-title":"Ophthalmic Physiol Opt"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"e398","DOI":"10.1111\/aos.12299","article-title":"Prevalence of myopia in school children in greater Beijing: the Beijing childhood eye study","volume":"92","author":"You","year":"2014","journal-title":"Acta Ophthalmol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e0187396","DOI":"10.1371\/journal.pone.0187396","article-title":"High myopia in greater Beijing school children in 2016","volume":"12","author":"Guo","year":"2017","journal-title":"PLoS One"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"101484","DOI":"10.1016\/j.lanwpc.2025.101484","article-title":"Prevalence and temporal trends in myopia and high myopia children in China: a systematic review and meta-analysis with projections from 2020 to 2050","volume":"55","author":"Pan","year":"2025","journal-title":"Lancet Reg Health West Pac"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"100837","DOI":"10.1016\/j.lanwpc.2023.100837","article-title":"Implementing a digital comprehensive myopia prevention and control strategy for children and adolescents in China: a cost-effectiveness analysis","volume":"38","author":"Li","year":"2023","journal-title":"Lancet Reg Health West Pac"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e0175921","DOI":"10.1371\/journal.pone.0175921","article-title":"Outdoor activity and myopia progression in 4-year follow-up of Chinese primary school children: the Beijing children eye study","volume":"12","author":"Guo","year":"2017","journal-title":"PLoS One"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"628","DOI":"10.1136\/bjophthalmol-2020-317811","article-title":"Refractive change and incidence of myopia among rural Chinese children: the Handan offspring myopia study","volume":"106","author":"Lin","year":"2022","journal-title":"Br J Ophthalmol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"M20","DOI":"10.1167\/iovs.18-25957","article-title":"IMI-defining and classifying myopia: a proposed set of standards for clinical and epidemiologic studies","volume":"60","author":"Flitcroft","year":"2019","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1016\/j.optom.2019.06.002","article-title":"Myopia and its progression in children in London, UK: a retrospective evaluation","volume":"13","author":"Wong","year":"2020","journal-title":"J Optom"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1186\/s12886-019-1281-0","article-title":"Prevalence of myopia and vision impairment in school students in eastern China","volume":"20","author":"Wang","year":"2020","journal-title":"BMC Ophthalmol"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1248","DOI":"10.1111\/opo.13366","article-title":"High myopia: reviews of myopia control strategies and myopia complications","volume":"44","author":"Shah","year":"2024","journal-title":"Ophthalmic Physiol Opt"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1111\/cxo.12978","article-title":"Role of un-correction, under-correction and over-correction of myopia as a strategy for slowing myopic progression","volume":"103","author":"Logan","year":"2020","journal-title":"Clin Exp Optom"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1007\/s10792-024-03175-w","article-title":"Benefits and risks of orthokeratology treatment: a systematic review and meta-analysis","volume":"44","author":"Sartor","year":"2024","journal-title":"Int Ophthalmol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1130","DOI":"10.21037\/tp-24-70","article-title":"Characteristics of astigmatism in school-age children aged 5 to 13 years in Northeast Sichuan: a cross-sectional school-based study","volume":"13","author":"Wang","year":"2024","journal-title":"Transl Pediatr"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"5205946","DOI":"10.1155\/2018\/5205946","article-title":"Refraction and ocular biometry of preschool children in Shanghai, China","author":"Zhang","year":"2018","journal-title":"J Ophthalmol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"604","DOI":"10.4103\/ijo.IJO_997_21","article-title":"Assessment of stereopsis in pediatric and adolescent spectacle-corrected refractive error - a cross-sectional study","volume":"70","author":"Elamurugan","year":"2022","journal-title":"Indian J Ophthalmol"},{"key":"ref22","first-page":"220","article-title":"Axial length to corneal radius of curvature ratio and refractive errors","volume":"8","author":"Hashemi","year":"2013","journal-title":"J Ophthalmic Vis Res"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1159\/000441900","article-title":"Axial length and associated factors in children: the Shandong children eye study","volume":"235","author":"Lu","year":"2016","journal-title":"Ophthalmologica"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"e0111766","DOI":"10.1371\/journal.pone.0111766","article-title":"Axial length\/corneal radius ratio: association with refractive state and role on myopia detection combined with visual acuity in Chinese schoolchildren","volume":"10","author":"He","year":"2015","journal-title":"PLoS One"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"317","DOI":"10.4321\/s0365-66912004000700004","article-title":"Changes in axial length\/corneal radius ratio (AL\/CR) according to refractive state of the eye. Relationship with ocular components","volume":"79","author":"Yebra-Pimentel","year":"2004","journal-title":"Arch Soc Esp Oftalmol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"859944","DOI":"10.3389\/fped.2022.859944","article-title":"The accuracy of the axial length and axial length\/corneal radius ratio for myopia assessment among Chinese children","volume":"10","author":"Mu","year":"2022","journal-title":"Front Pediatr"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1136\/bjophthalmol-2021-319431","article-title":"Normative data and percentile curves for axial length and axial length\/corneal curvature in Chinese children and adolescents aged 4-18 years","volume":"107","author":"He","year":"2023","journal-title":"Br J Ophthalmol"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"569","DOI":"10.4103\/njcp.njcp_1277_21","article-title":"Ocular biometry characteristics and its relationship with age, gender, spherical equivalent in Turkish children","volume":"25","author":"Dayi","year":"2022","journal-title":"Niger J Clin Pract"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"AC01-4","DOI":"10.7860\/JCDR\/2015\/10555.5445","article-title":"Variation of axial ocular dimensions with age, sex, height, BMI-and their relation to refractive status","volume":"9","author":"Roy","year":"2015","journal-title":"J Clin Diagn Res"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"936738","DOI":"10.3389\/fmed.2022.936738","article-title":"Sex differences in ocular biometric measurements: a twin study","volume":"9","author":"Zhang","year":"2022","journal-title":"Front Med"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1660018\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T05:30:21Z","timestamp":1758519021000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1660018\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,22]]},"references-count":30,"alternative-id":["10.3389\/fpubh.2025.1660018"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1660018","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,22]]},"article-number":"1660018"}}